Health Services Academy

Institute of Health & Management Sciences

Islamabad

ADMISSION FORM DIPLOMA PROGRAMS

Instructions:
1. Use CAPITAL letters and write your exact details as they appear in your Photograph
documents.

Program of Study

Name Father Name

Gender CNIC No

Date of Birth Experience

(DD/MM/YYYY) 1 Year

Passport No Nationality

Domicile Student National/International

O National O International

Domicile District Phone No

Mob No Office No

Email Postal Address

Academic Qualification (most recent first) (provide attested copies)

Marks Passing
Name of Institute Degree Level Degree Name Total Marks
Obtained year

Experiences (provide attested copies)

Date Date of
Name of Institute Major Responsibility
Employed Resignation

Applicant Signature